Primary pediatricians are faced with 1/4 or more of their patients who are at risk of obesity or who are obese. Data suggest that physicians may under-diagnose obesity in children, and pediatricians report many barriers to treatment of childhood obesity. This Mentored Clinical Scientist Development Award application proposes to improve communication about childhood and adolescent obesity in the offices of pediatricians. The first study aim is to describe the current frequency of evaluation of obesity in children 6 to 17 years of age by pediatricians. Brief questionnaires completed by pediatricians in private practice and urban public practice will be used to examine association of discussion of obesity with presence of obesity by BMI calculation. The second aim of the study is to assess experiences and attitudes of pediatricians in diagnosing and discussing this condition, with particular attention to the interpersonal barriers to labeling a child as overweight. Interviews with pediatricians from a variety of practice settings will be conducted and analyzed with qualitative methods. The third aim of the study is to assess experiences and attitudes of adolescents and of parents of elementary school age children in discussing obesity with the pediatrician to learn what approaches are acceptable or alienate or motivate them. Focus groups of adolescents and of parents of school age children will be conducted and analyzed with qualitative methods. Participants will be chosen to sample a variety of demographic backgrounds. The fourth aim is to test the effect on pediatricians' self-efficacy of an intervention that teaches pediatricians how to address obesity to create an alliance with patients and families and motivate them to make changes. The analysis of the interviews and focus groups will inform the content of the educational program, and the effect of the program will be assessed with pre- and post-testing of pediatricians. This work will lead to a study of the impact of physician behavior on patient outcomes, including family and patient motivation to change, reported behavior change, and ultimately patient weight status. Strategies for provider behavior may need to be tailored to patient age, racial-ethnic background, or socio-economic status.